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Breastfeeding basics: advice for new mums

Despite numerous initiatives to support breastfeeding mothers, breastfeeding rates continue to drop dramatically within weeks of delivery. This appears to be due to lack of confidence and not, as often mentioned, breastfeeding technique. Sharon Trotter explains how health professionals can reverse this trend and boost the confidence of new mothers

Sharon Trotter
RM BSc
Midwife
Mother and Baby Consultant
TIPS Ltd

Recent figures published by the Department of Health show that although the initiation of breastfeeding has risen by 7% to 77% in the past five years, the drop-off rates in the first few weeks of life are alarmingly steep, with only 1% of mothers still exclusively breastfeeding their infant by six months of age.(1)
Exclusive breastfeeding during the first six months of life provides for all the nutritional needs of a baby. Half of these needs can still be met by breastfeeding in the period from six to 12 months. From 12 to 24 months a baby will still receive a third of its nutritional requirements from breast milk alone.(2)
Early drop off in breastfeeding may be influenced by a number of factors. A generation of bottlefeeding mothers is partly responsible for eroding the primary skills needed to support and empower women during breastfeeding. Such skills need to be relearned so that women can once again tune into their own instincts and their baby's needs.
New mothers no longer have the luxury of long hospital stays or the support of an extended family to help them establish successful breastfeeding.(3)
Breastfeeding technique plays its part, but confusing diagrams or hands-on manipulation may not be constructive. Successful breastfeeding has more to do with building and sustaining confidence.
Cultural issues (such as the association of breasts with sex in Western society) also play a part and it will take time for attitudes to change. Such are the issues that the Scottish government had to pass legislation guaranteeing women's rights to breastfeed in public (English legislation is set to follow suit shortly).(4) This is helpful, but we still have a long way to go before breastfeeding is accepted as the infant feeding norm.
According to a new telephone poll conducted by Kamillosan, one in four top British restaurants bans breastfeeding.(5)
Kamillosan also surveyed 3,500 mums across the nation and the survey revealed that new mums are terrified at the thought of breastfeeding in public. Thirty-eight percent of mothers prefer to breastfeed in public lavatories than face disapproving glares from strangers. A fifth of mums are so worried about other people's opinions they opted to leave the baby screaming for milk rather than breastfeed.(6)
In fact, the natural bonding experience is ruined for many by negative reactions, inappropriate comments and blatant stares. A staggering 54% of breastfeeding mothers say they have been subjected to unwanted attention.
The question remains as to why, with all evidence pointing to a need for consistent advice and ongoing support for breastfeeding, especially in the early days after delivery, mothers are still left wanting?(7)

Inconsistent advice - is this the biggest barrier to success?
In an online poll, 125 mothers reported their top three breastfeeding problems.(8) Eighty percent of those problems were directly associated with conflicting advice. This led to physical difficulties (such as sore nipples, blocked ducts, mastitis, thrush and tongue-tie) as well as psychological problems (mainly lack of confidence caused by conflicting advice).
When it comes to breastfeeding advice, midwives are the key source of information for new mothers. A National Childbirth Trust (NCT) survey found that 77% of women receive breastfeeding information from midwives during their pregnancy, while 20% get information from health visitors and 7% from GPs.(9) Yet, nearly half of the women surveyed said they did not receive as much support as they needed regarding breastfeeding. As a result of this, more than 50% of women stopped breastfeeding sooner than they would have liked.
Women who took part in the Healthcare Commission 2007 survey of NHS maternity services were asked about the advice and support they had received from midwives and other healthcare professionals in relation to feeding their baby (breast or bottle).(10) Almost two-thirds of women surveyed  felt that they did not receive consistent advice, practical help or active support and encouragement.
NICE guidance for routine postnatal care of women and their babies recommends that all maternity care providers (whether in a hospital or primary care setting) should implement an externally-evaluated structured programme that encourages breastfeeding using the Baby Friendly Initiative as a minimum standard (see Resources).(11)
Currently, only 10% of women give birth in a fully accredited Baby Friendly hospital. Although breastfeeding rates are considerably higher in such units, there remains a reluctance to implement this standard. This is despite the fact that hospitals with low breastfeeding rates can see these double when they become Baby Friendly. Even hospitals with relatively high breastfeeding rates can see this increase by at least 10% with associated savings due to reduced instances of childhood illnesses such as gastroenteritis, asthma and middle-ear infection.
A national breastfeeding helpline was launched in February 2008 with a yearly funding of £150,000.(12) This service is staffed by trained volunteers from the Breastfeeding Network and the Association of Breastfeeding Mothers who answer calls from their own home. The lines are open from 9.30am to 9.30pm. This falls far short of the 24-hour service breastfeeding mothers need, as problems are unlikely to be confined to daylight hours. The fact that this service is run by volunteers places undue pressure on women who are likely to be busy with young families of their own. Until provision is made for a fully-funded helpline (manned by lactation consultants - possibly as part of the NHS 24-hour advice service), women are unlikely to receive the support they deserve when they need it.

Building confidence is the key to success
As a breastfeeding consultant and author of Breastfeeding - The Essential Guide, I am all too aware of the common concerns (not necessarily problems) associated with the early days of breastfeeding.(13) As already explained, these may include a variety of conditions that must be diagnosed promptly by someone who really understands how breastfeeding works and is able to help correct any aspect of the breastfeeding technique. Central to this process is confidence building.
Being a new parent is stressful. Evidence shows that mothers who receive support from someone who believes they can breastfeed will breastfeed for longer.(14) Such level of supportive advice from someone the mother trusts, together with support from peers (family, friends or breastfeeding support group) is of most help.

Conclusion
It is ironic that the introduction of artificial baby milks in the 1950s, as a way of enticing women into health clinics, has led the trend towards bottlefeeding as we know it today.(15) The multimillion pound promotion of these baby milks uses ever more sophisticated marketing techniques to lull parents into thinking that these products are the next-best-thing to breast milk. In reality this could not be further from the truth and the ill effects of widespread formula feeding on infant health and indeed on public health are huge. These include increased financial pressures due to ill health on our already overstretched health service. This situation will not change overnight, but the more aware we become of the short- and long-term benefits of breastfeeding for mother and baby, the more we will understand the need for effective breastfeeding support to be a top priority rather than an afterthought.(3) To achieve this, we must ensure that health professionals are adequately trained. However, it is also essential for support to be targeted more effectively in the early weeks of breastfeeding and for a national helpline manned by lactation consultants to be established.
There are very few difficulties that cannot be resolved and even fewer reasons why women cannot establish successful breastfeeding.

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Resources
The Baby Friendly Initiative
W: www.babyfriendly.org.uk

Biological Nurturing
W: www.biologicalnurturing.com

References

  1. NHS Information Centre. National infant feeding survey 2005. Available from: http://www.ic.nhs.uk
  2. WHO. Child and adolescent health and development. 2006. Available from: http://www.who.int/child-adolescenthealth/NUTRITION/infant_exclusive.htm
  3. National Perinatal Epidemiology Unit. Recorded delivery: a national survey of women' experience of maternity care 2006. Available from: http://www.npeu.ox.ac.uk/downloads/maternitysurveys/maternity-survey-rep...
  4. OPSI. Breastfeeding etc (Scotland) Act 2005. Available from: http://www.opsi.gov.uk/legislation/scotland/acts2005/asp_20050001_en_1
  5. Kamillosan. Telephone poll of 100 restaurants to gauge reaction of breastfeeding in public. 2008. Available on request from info@kamillosan.co.uk
  6. Kamillosan. Online survey of 3500 mothers regarding views on breastfeeding in public. 2008. Available on request from info@kamillosan.co.uk
  7. Dhandapany G, Bethou A, Arunagirinathan A, et al. Antenatal counselling on breastfeeding - is it adequate? A descriptive study from Pondicherry, India. Int Breastfeed J 2008;4:5.
  8. Trotter S. Online poll of top three breastfeeding problems carried out between 2007-2008. Available on request from www.tipslimited.com
  9. National Childbirth Trust. Midwives top chart for breastfeeding information. 2006. Available from: http://www.nct.org.uk/press-office/press-releases/view/13
  10. Healthcare Commission. Women's experiences of maternity care in the NHS in England. Key findings from a survey of NHS trusts carried out in 2007. Available from: http://www.healthcare commission.org.uk
  11. NICE. Postnatal care: routine postnatal care of women and their babies. Costing report. 2006. Available from: http://www.nice.org.uk/nicemedia/pdf/implementation_tools/cg37costingrep...
  12. Department of Health. National breastfeeding helpline launched. 2008. Available from: http://nds.coi.gov.uk/Content/Detail.asp?ReleaseID=352806&NewsAreaID=2
  13. Trotter S. Breastfeeding: the essential guide. Scotland, TIPS Ltd; 2004.
  14. BBC News. More breastfeeding support needed. 2008. Available from: http://news.bbc.co.uk/1/hi/health/7245218.stm
  15. Palmer G. The politics of breastfeeding. London: Pandora; 1993.
  16. Lee N. Breastfeeding recovery: more tools for the helpers. Midirs Midwifery Digest 2005;15:229-33.
  17. Palfreyman SJ, Nelson EA, Lochiel R, et al. Dressings for healing venous leg ulcers. Cochrane Database Systematic Rev 2006;3:CD001103.DOI: 10.1002/14651858.
  18. Huml S. Sore nipples: a new look at an old problem through the eyes of a dermatologist. Pract Midwife 1999;2:28-31.